As one component of the "NIH/DC Initiative to Reduce Infant Mortality" a comprehensive, city-wide injury surveillance system was established which collected data about injuries in children <3 years of age that resulted in an emergency room visit, hospitalization or death. Information about substantiated cases of abuse and neglect was also obtained from the Department of Family Services. Data collection is complete. Preliminary figures on accrual rates are available for all ten study hospitals. For the one year period from October 1, 1995 through September 30, 1996, 3039 injury-related visits were identified yielding an annual event-based rate of 13.5/100 persons/year. There were nine deaths, 163 hospitalizations, and 2,867 emergency department visits. Injury rates were highest in one-two year olds and lowest in infants. Leading causes of injury varied with severity. Intentional injuries and injuries where intent was undetermined but suspicious of being intentional, comprised the largest fraction of deaths (n=4, 44%) and hospitalizations (n=36, 22%). In contrast intentional injuries and injuries of undetermined intent accounted for only 2% of ED visits (n=56). Forty-two percent of injury-related ED visits were for falls (n=1245). At three of the study sites a questionnaire was administered to the parent or care giver shortly after the injury event. Of the 1913 families who were eligible for an interview, 1,445 (77%) were contacted and interviews were completed for 1,352 (93% of contacts). A manuscript reporting parental sensitivities to the interview was published in Injury Prevention and a second manuscript reporting issues related the design and implementation of a multi-hospital injury surveillance system was reported in the American Journal of Emergency Medicine. Current efforts are focused on analyses of the circumstances surrounding injury events to provide insight to potential strategies for prevention.